In the absence of formal registry data, the volume of organ failure in Syria and the cause are difficult to establish with certainty; however, we have tried in this study to evaluate the extent of organ failure by collecting data from health care authorities and different medical institutions who are involved in caring of patients with organ failure, and then we assessed the problem of the widening gap between organ request and availability in our country and highlighted the obstacles to initiate a national cadaver donation program as a viable option to address the challenge of organ shortage. Volume of organ failure: the estimated prevalence of corneal blindness in Syria is 2.3 per one thousand population. The estimated incidence of viral cirrhosis is 49 – 67 per one million population, these include both HCV and HBV which constitute the leading cause of liver failure however, since we are lacking national registry, we do not know precisely the incidence of other known causes of liver failure. We estimated the incidence of end stage renal disease (ESRD) to be 80 – 100 per one million population. The estimated prevalence of ESRD patients undergoing dialysis in May 2005 is 143 per one million population; but unfortunately, we do not have data on the percentage of ESRD patients who receive dialysis. •Obstacles to initiate a national cadaver donation program: Lack of societal awareness and acceptance, and the attitude of indifferent health care professionals have been identified as a major limiting factor. Other obstacles include difficulties in providing the following: adequate resources in term of finance personnel and services, establishment of a national center for organ transplantation, influencing public attitude, national guidelines and data bank for organ failure, trained organ procurement professionals including transplant coordinators, ascertained ICU standard care, and comprehensive tissue center. The success of a national cadaver donation program requires several factors to be addressed.